This author interviewed Donna Cartwright, MPA, RHIA, CCS, RAC, FAHIMA, President, Donna J. Cartwright and Associates LLC, who explained how she worked together with 3M and the Wound, Ostomy, and Continence Nurses (WOCN) Society to apply for and receive eight new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for moisture-associated skin damage (MASD).
Even though there are thousands of ICD-10-CM codes, wound/ulcer management professionals often complain that they cannot accurately report some skin issues. This author always reminds them that their professional society can apply for new ICD-10-CM codes if they have the required evidence and an ICD-10-CM expert/consultant to assist them navigate the application process. To prove that requesting and receiving new ICD-10-CM codes are possible, this article describes a BIG WIN for wound/ulcer management patients and professionals.
Several years ago, this author received a call from the reimbursement manager at 3M. She explained that the WOCN Society was looking for a coding consultant who could assist them to acquire new ICD-10-CM diagnosis codes for MASD, which develops from prolonged exposure of the skin to moisture and irritants that result in irritant contact dermatitis. Because ICD-10-CM coding is not this author's expertise, I referred 3M and the WOCN Society to Donna Cartwright, who is an ICD-10-CM trainer and has assisted many organizations to create new diagnosis codes.
For the past year and a half, Donna consulted with three members of the WOCN Society to create the application for the new diagnosis codes. Now that the work is complete, this author interviewed Donna so that she could share the ICD-10-CM process and fabulous outcome with you.
Kathleen Schaum (KS):Thank you for agreeing to this interview. When did this ICD-10-CM coding application project begin?
Donna Cartwright (DC): I am glad to share information with the readers and was honored to be referred to 3M and the WOCN Society. The project team was formed in October of 2020.
KS:Before you began the project, did any ICD-10-CM codes describe irritant contact dermatitis?
DC: Yes, but the existing code for irritant contact dermatitis (ICD 10-CM code L24) included a variety of potentially irritating substances to the skin such as detergents, oils, greases, solvents, drugs, plants, and metals. This code did not cover the clinically relevant and prevalent forms of irritant contact dermatitis caused by body fluids.
KS:What are the most prevalent forms of irritant contact dermatitis?
DC: The four most prevalent forms of irritant contact dermatitis are incontinence-associated dermatitis, intertriginous dermatitis, peristomal MASD, and periwound MASD.
KS:So, how did the wound/ulcer management professionals report irritant contact dermatitis?
DC: When these conditions were documented in the medical record, the wound/ulcer management professionals only had the choice of inappropriate, nonspecific, or miscellaneous diagnosis codes to report MASD conditions. Using the nonspecific codes did not accurately describe the presence, management, and outcomes of these specific conditions.
KS:Did any ICD-10-CM codes describe MASD?
DC: As of January 2020, only one code described MASD in adults: L30.4 erythema intertrigo, which may also be used to specify conditions or terms such as abrasion of the hand, chafing of skin, dermatitis due to sweating and friction, friction dermatitis of children, friction eczema, genitocrural (genital/thigh) intertrigo, etc.
Because there is a worldwide shift in demographics toward an aging population, and because MASD is a common condition among older adults, its prevalence is likely to rise. Therefore, unique ICD-10-CM codes for all types of MASD were needed to appropriately report the conditions, improve data collection, and facilitate research.
KS:Now that we understand the diagnosis code gap, will you please outline the types of evidence and information that were required to create the new ICD-10-CM codes?
DC: To prove that a need existed for the new diagnosis codes, we gathered the following evidence and information:
* An explanation of why MASD conditions are increasing among older adults
* Clarification that uniform definitions for these conditions are lacking (many different terms are often used to describe the same conditions)
* A description from the WOCN Society indicating why specific diagnosis codes were needed to report and track these conditions for incidence and research
* A list of the existing ICD-10-CM codes, showing that specific codes for irritant contact dermatitis due to body fluids did not exist
* A thorough literature summary and bibliography, including pictures and descriptions of the distinct types of conditions
KS:Once the evidence and information were collected, what were the major steps of the ICD-10-CM application process?
DC: The major steps of the application process were as follows:
* The WOCN Society workgroup assembled and submitted the application, which included the proposed new ICD-10-CM codes, a needs assessment for the unique codes, the literature review and summary, and a bibliography.
* The original proposal was presented at the March 17-18, 2020, Coordination and Maintenance Committee Meeting of the National Center for Health Statistics, which is responsible for the ICD-10-CM diagnosis codes used in the US.
* The WOCN Society workgroup responded to the questions received from the committee and the public during the March 2020 meeting.
* The responses to the inquiries were accepted with no further comments. The revised proposal was approved at the September 2021 meeting.
KS:When were the new ICD-10-CM codes finalized?
DC: The new codes went into effect on October 1, 2021, and they were published in the Medicare Program Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates.
KS:What are the new codes and how are they displayed in the 2022 ICD-10-CM tabular listing?
DC: Before I list the new codes, I would like to remind readers about the meaning of the "Excludes" notes. "Excludes1" means that the code should not be reported in addition to the code listed above it. "Excludes2" means that the two codes can be reported together if the patient has both conditions at the same time. Now, let us review four of the new codes that are listed under the subcategory:
L24.A Irritant contact dermatitis due to friction or contact with body fluids
Excludes1: irritant contact dermatitis related to stoma or fistula (L24.B-)
Excludes2: erythema intertrigo (L30.4)
L24.A0 Irritant contact dermatitis due to friction or contact with body fluids, unspecified
L24.A1 Irritant contact dermatitis due to saliva
L24.A2 Irritant contact dermatitis due to fecal, urinary, or dual incontinence
Excludes1: diaper dermatitis (L22)
L24.A9 Irritant contact dermatitis due to friction or contact with other specified body fluids
Irritant contact dermatitis related to endotracheal tube
Wound fluids, exudate
Finally, let us discuss the four new codes that are listed under the subcategory:
L24.B. Irritant contact dermatitis related to stoma or fistula
Use Additional Code to identify any artificial opening status (Z93.-), if applicable, for contact dermatitis related to stoma or secretions
L24.B0 Irritant contact dermatitis related to unspecified stoma or fistula
Irritant contact dermatitis related to stoma NOS
Irritant contact dermatitis related to stoma NOS
L24.B1 Irritant contact dermatitis related to digestive stoma or fistula
Irritant contact dermatitis related to gastrostomy
Irritant contact dermatitis related to jejunostomy
Irritant contact dermatitis related to saliva or spit fistula
L24.B2 Irritant contact dermatitis related to respiratory stoma or fistula
Irritant contact dermatitis related to tracheostomy
L24.B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula
Irritant contact dermatitis related to colostomy
Irritant contact dermatitis related to enterocutaneous fistula
Irritant contact dermatitis related to ileostomy
As I mentioned before, the diagnosis code L30.4 erythema intertrigo was already listed under subcategory L30 Other and unspecified dermatitis.
KS:Now that the codes exist, do you have any tips for the readers to incorporate these codes into their documentation, their electronic health records, and their coding and charging systems?
DC: Yes. Now that specific diagnosis codes are available for the distinct types of MASD, all wound/ulcer management professionals should incorporate the specific terminology into clinical assessments, documentation, and coding. The clinical staff should refine their documentation of these conditions to align with the new code descriptions and educate coders about these new codes and the refined documentation. In addition, the electronic health records, the coding systems, and the charging systems should be updated.
KS:Thank you, Donna. If readers and/or their professional societies would like to contact you for assistance in applying for new ICD-10-CM diagnosis codes, how can they reach you?
DC: I would be honored to consult with other wound/ulcer management professionals and/or their professional societies. My email address is mailto:[email protected], and my cell phone number is 609-477-9304.